title: Acute exacerbation of chronic obstructive pulmonary disease: influence of social factors in determining length of hospital stay and readmission rates.
abstract: BACKGROUND
  Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources.
  
  
  OBJECTIVE
  To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital.
  
  
  METHODS
  Using the Providence Health Records, a retrospective review of patients admitted to St Paul's Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched.
  
  
  RESULTS
  Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P<0.001), number of related comorbidities (OR 1.47, 95% CI 1.10 to 1.97; P<0.009) and marital status (single) (OR 4.18, 95% CI 1.03 to 17.02; P<0.046). The requirement for social work involvement during hospital admission was associated with a prolonged LOS (P<0.05).
  
  
  CONCLUSIONS
  The results of the present study show that disease severity (GOLD status) and number of comorbidities are associated with readmission rates of patients with AECOPD. Interestingly, social factors such as marital status and the need for social work intervention are also linked to readmission rates and LOS, respectively, in patients with AECOPD.
authors.affiliation: The James iCAPTURE Centre for Cardiovascular and pulmonary Research, Heart and Lung Institute, St Paul's Hospital, Providence Healthcare, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alyson W M
authors.initials: AW
authors.lastname: Wong
authors.forename: Wen Q
authors.initials: WQ
authors.lastname: Gan
authors.forename: Jane
authors.initials: J
authors.lastname: Burns
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: Sephan F
authors.initials: SF
authors.lastname: van Eeden
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D012008:Recurrence; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors